This is regarding hospital billing for a neurology group. We have had several claims where the patient was in the hospital for over 72 hours (sometimes a week) and they are listed as outpatient or observation for the entire stay. The hospital is unable to get the auth to make them an inpatient.
We bill using outpatient codes for the visits. We can not use the Observation codes since we are not the attending/admitting doctor. Usually the patients end up with copays for each day and sometimes denials for no referral if they needed one. One claim was denied and the insurance is saying the hospital billed ER codes for the 3 days the patient was there.
Is coding with out patient codes the proper way to bill for these? Can we use the ER codes as well?
Also a general question. How is this possible that patients can be in the hospital for a week as an out patient? I thought there was a 72 hour limit.
Thank you so much. After 8 years of billing and coding I still get overwhelmed by E/M coding.
We bill using outpatient codes for the visits. We can not use the Observation codes since we are not the attending/admitting doctor. Usually the patients end up with copays for each day and sometimes denials for no referral if they needed one. One claim was denied and the insurance is saying the hospital billed ER codes for the 3 days the patient was there.
Is coding with out patient codes the proper way to bill for these? Can we use the ER codes as well?
Also a general question. How is this possible that patients can be in the hospital for a week as an out patient? I thought there was a 72 hour limit.
Thank you so much. After 8 years of billing and coding I still get overwhelmed by E/M coding.
Hospital Outpatient longer than 72 hours
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